Quality Improvement RN
We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization. Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical).
Our Mission.. Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.
Under the direction of the Director of Quality Improvement (QI), the QI Nurse will assist in clinical activities related to monitoring, assessing and improving performance in ambulatory and inpatient health care delivery or health care related services to Kern Health Systems (KHS) membership. The QI Nurse will assist in the implementation of the KHS QI Program Plan and communicate with contracted providers regarding studies, and will participate in facility site reviews, record reviews, chart abstractions and copying records as part of the general QI reporting process which includes data collection, tabulation and report writing.
This position is responsible for assigned Quality Improvement functions for a Knox-Keene Licensed health maintenance organization (HMO).
MAJOR DUTIES AND RESPONSIBILITIES
- Assist in the implementation of the QI Program Plan and Program Workplan
- Performs QI activities related to State required Quality requirements
- Serves as knowledge expert for QI activities
- Achieves State certification as a facility site reviewer and conducts facility site reviews for credentialing and re-credentialing of practitioners and providers as needed. Certification is provided through KHS
- Participates in record reviews/abstractions/copying
- Prepares and reports physician specific findings to the Director of QI
- Assists in problem identification, data analysis, conclusions, recommendations, and action plans
- Monitors and analyzes outcomes to ensure goals, objectives, outcomes, and regulatory requirements are met
- Assist in preparation of reports for committees
- Assists in activities to prioritize QI initiatives
- Ensures that documentation produced and/or processed complies with State and Federal regulations
- Assists with training for new employees
- Assists with internal QI investigations such as records reviews for member complaints involving possible Quality of Care issues
- Assists in problem identification, data analysis, conclusions, recommendations, action plan design, follow-up and tracking
- Performs all job functions in a safe manner
- Provides input in support of State and Federal requirements as it pertains to the mandated managed care accountability set measures
- Maintains the confidentiality of records and reports for both KHS members and contracted providers
- Performs in-depth medical records reviews as needed and is able to write a professional, clinical summary
- Knowledge of acute care nursing principles, methods, and commonly used procedures
- Knowledge of medical terminology, hospital routine; and commonly used medical equipment
- Knowledge of acute hospital organizations and inter-relationships of various clinical and diagnostic services
- Performs other job-related duties as required
CORE COMPENTENCIES / KNOWLEDGE & SKILL REQUIREMENTS
- Thorough knowledge of health care delivery systems
- Knowledge of State and Federal managed care regulatory requirements
- Ability to read, interpret and apply written regulations, guidelines and other materials
- Strong analytical, assessment and problem-solving skill
- Very strong interpersonal skills, including the ability to establish and maintain effective working relationships with individual at all levels both inside and outside of KHS
- Ability to use tact and diplomacy to diffuse emotional situations
- Effective oral and written communication skills, including the ability to effectively explain complex information and document according to standards
- Intermediate skills in Word, Excel, PowerPoint, and Outlook, with basic ability to enter data into and navigate through a database
- Ability to commit to and facilitate an atmosphere of collaboration and team work
- Knowledge of provider documentation requirements and governmental regulations affecting reimbursement
- Demonstrated ability to respect and maintain the confidentiality of all sensitive documents, records, discussions and other information generated in connection with activities conducted in, or related to, patient healthcare, KHS business or employee information
- Compliant with KHS policies and procedures; performs the job safely and with respect to others, to property, and to individual safety. Other duties as assigned
- Associate Degree in Nursing required; Bachelor’s Degree preferred;
- Possession of a valid California Registered Nursing License and in good standing;
- Three (3) years of RN experience in a direct patient care setting preferred;
- One (1) year experience in Utilization Management or QI in a healthcare delivery or managed care setting required.
**If not currently certified by DHCS, the successful candidate must obtain Facility Site Review (FSR) certification within one (1) year of hire date.
Other: Possession of valid driver’s license and proof of State required auto liability insurance.
Up to 50% driving required.
We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.